The Southwest Respiratory and Critical Care Chronicleshttp://pulmonarychronicles.com/index.php/pulmonarychronicles
<p>The Southwest Respiratory and Critical Care Chronicles is an online publication first published on January 15 2013. We publish original articles, reviews, commentary on public policy, educational updates, case reports, images, and letters. SRCCC is sponsored and supported by the Department of Internal Medicine at Texas Tech University Health Sciences Center in Lubbock, Texas. The sponsoring organization is a large, state supported health sciences center with extensive experience in education, medical care, and research.</p><p>The Editorial Board maintains the scientific integrity of this journal and its operation. The Editorial Board has a significant aggregate experience in internal medicine, pulmonary medicine, critical care medicine, and data analysis. All Editorial Board members are based in departments of internal medicine at medical schools or health science centers or in departments of statistics at universities. </p><p><strong>Visit us on <a href="https://www.facebook.com/TheSouthwestRespiratoryAndCriticalCareChronicles/">Facebook</a></strong></p><p><strong><br /></strong></p>Texas Tech University Health Sciences Centeren-USThe Southwest Respiratory and Critical Care Chronicles2325-9205<p>This Journal applies the Creative Commons Attribution Share Alike License to works we publish. It offers open access. Authors retain the copyright.</p>

PCSK9 inhibition – Ready for prime time?http://pulmonarychronicles.com/index.php/pulmonarychronicles/article/view/417
Scott Schumur
Copyright (c) 2017 Scott Schumur
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2017-10-162017-10-165211310.12746/swrccc.v5i21.417Fibrosing Mediastinitishttp://pulmonarychronicles.com/index.php/pulmonarychronicles/article/view/419
<p>Fibrosing mediastinitis is an uncommon thoracic disorder characterized by the extensive<br />proliferation of fibrous tissue in the mediastinum. This disorder frequently develops following<br />Histoplasma capsulatum infection with involvement of mediastinal lymph nodes. The fibrous<br />tissue can invade and compress mediastinal structures, including vessels, large airways, and<br />the esophagus. These patients may present with cough, sputum production, and dyspnea<br />depending on location and extent of fibrosis. The radiographic presentation depends on the<br />type and extent of obstruction. Diagnosis requires computed tomography with angiography,<br />ventilation-perfusion scans, and pulmonary function tests. Management depends on the<br />structures involved and the extent of infiltration and/or compression. Possible approaches<br />include the use of endobronchial stents, intravascular stents, vascular bypass grafts, and<br />the resection of nonfunctional pulmonary tissue. Extensive surgical procedures are usually<br />not warranted. These patients usually do not respond to antifungal or anti-inflammatory<br />medications. Several patients have responded to rituximab, and this drug is a possible<br />consideration in patients with ongoing inflammation in the mediastinum.</p>Tatiana DenegaHawa EdrissDavid SotelloKenneth Nugent
Copyright (c) 2017 Tatiana Denega, Hawa Edriss, David Sotello, Kenneth Nugent
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2017-10-162017-10-1652141010.12746/swrccc.v5i21.419Kcentra® (Prothrombin Complex Concentrate [Human]): Its indications, side effects, and contraindicationshttp://pulmonarychronicles.com/index.php/pulmonarychronicles/article/view/423
<p>Patients with a high risk for thromboembolic events can be on long-term warfarin. These<br />patients need close monitoring of their INR and for signs of bleeding. Conventionally, fresh<br />frozen plasma (FFP) is used for reversal of INR in patients with major bleeding or who need<br />urgent surgery or invasive procedures. Kcentra is now available as an alternative to FFP for<br />rapid reversal of INR and urgent hemostasis.</p>Amr Ismail
Copyright (c) 2017 Amr Ismail
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2017-10-162017-10-16521111510.12746/swrccc.v5i21.423Depression is associated with lower American National Adult Reading Test scores among rural dwellers aged between 50 and 64 years in Texas: A Project FRONTIER Studyhttp://pulmonarychronicles.com/index.php/pulmonarychronicles/article/view/420
<p>Background: Previous studies have shown that depression is associated with cognitive<br />impairment. However, others have shown that there is no significant difference in the scores<br />of the National Adult Reading Test (NART), a screening test for intellectual functioning and<br />general level of education, between those with vs. without depression. This study sought to<br />examine whether depression is associated with the American version of NART (AMNART) in<br />a rural cohort of West Texas.<br />Methods: Participants with IQ and AMNART tests were selected from Project FRONTIER,<br />an ongoing epidemiology study of rural residents in four West Texas counties.<br />Results: AMNART scores were significantly lower in participants with depression<br />(23.3±9.2) vs. those without depression (25.9±9.9) (p&lt;0.05). Analysis by age group showed<br />that AMNART scores were significantly lower in those with depression (22.0±10.1) compared<br />with those without depression (26.2±10.2) in the age group 50 to 64 years (P=0.0322). Although<br />AMNART scores were lower in participants with depression than those without depression in<br />the age groups 40 to 49 years (25.0±8.6 vs. 26.2±10.2) and 65 years or older (23.6±8.2 vs.<br />25.6±9.5), they were not statistically significantly different.<br />Conclusions: Depression is associated with lower AMNART scores in rural residents<br />aged between 50 and 64 years in West Texas.</p>Brady MillerCatherine HudsonGordon Gong
Copyright (c) 2017 Brady Miller, Catherine Hudson, Gordon Gong
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2017-10-162017-10-16521162010.12746/swrccc.v5i21.420Coal worker’s pneumoconiosis and sarcoid-like reaction mimicking lymph node metastases in a patient with lung cancer: A case reporthttp://pulmonarychronicles.com/index.php/pulmonarychronicles/article/view/421
<p>Sarcoid-like reactions occur in a small percentage of cancer patients. This reaction causes<br />lymph nodes to appear hypermetabolic when viewed with Fludeoxyglucose-Positron Emission<br />Tomography (FDG-PET). This is clinically important, because it could be confused with tumor<br />metastasis and could affect the staging and treatment of the cancer. In addition to sarcoid-like<br />reactions and metastasis, several other disease processes can cause lymph nodes to appear<br />hypermetabolic with FDG-PET, including coal worker’s pneumoconiosis. We present the case<br />of a 61-year-old coal miner who was diagnosed with lung cancer. FDG-PET showed increased<br />uptake in ipsilateral and contralateral mediastinal lymph. The patient had bronchoscopy with<br />endobronchial ultrasound (EBUS) guided biopsy of the mass and needle aspiration of bilateral<br />lymph nodes of the mediastinum. All the biopsies were negative. The patient then had a left<br />upper lobectomy and left mediastinal lymph node dissection. The PET findings were originally<br />attributed to metastasis of the tumor, but pathology of the ipsilateral nodes showed silicotic<br />changes due to pneumoconiosis and non-caseating granulomas from a sarcoid-like reaction.<br />Because the ipsilateral lymph nodes had no evidence of metastasis and EBUS biopsy of<br />the contralateral nodes was negative, it was unlikely that the changes in the contralateral<br />nodes were due to metastasis, and no adjuvant treatment was offered. At more than one<br />year after surgery, the patient remains stable with no evidence of recurrence, and we have<br />clinical assurance that the changes in the lymph nodes were due to the sarcoid-like reaction<br />and pneumoconiosis and not metastasis. FDG-PET is useful for detection of lung cancer, but<br />pathology is necessary for staging and determining treatment for the patient.</p>Chad DuncanLukman TijaniSuzanne GrahamRuc TranCynthia Jumper
Copyright (c) 2017 Chad Duncan, Lukman Tijani, Suzanne Graham, Ruc Tran, Cynthia Jumper
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2017-10-162017-10-16521212510.12746/swrccc.v5i21.421Metastatic carcinoid tumor with severe double valve disease at diagnosis: Case report and review of literaturehttp://pulmonarychronicles.com/index.php/pulmonarychronicles/article/view/416
<p>A 27-year-old woman with a history of anxiety presented with three months of diarrhea. On<br />physical examination, she had a grade 3/6 systolic heart murmur at the lower left sternal border<br />which increased with inspiration, a grade 2/6 decrescendo diastolic murmur at the left sternal<br />border, and lower extremity edema. Stool studies were negative. The abdominal ultrasound<br />demonstrated multiple complex liver cysts. Transthoracic echocardiogram reported tricuspid<br />valvular thickening with stenosis and regurgitation, severe pulmonary stenosis, and mild aortic<br />regurgitation with valvular thickening. 5-hydroxyindole acetic acid and chromogranin A levels<br />were elevated. The patient’s symptoms improved after octreotide therapy, and she underwent<br />tricuspid and pulmonary valve replacement.<br />The incidence of carcinoid tumors is 1.2 to 2.1 per 100,000 people in the general population.<br />Carcinoid heart disease occurs in one-half to two-thirds of patients with carcinoid syndrome<br />and is associated with poorer clinical outcomes. Left side cardiac involvement occurs in less<br />than 10% of patients. The presence of both left and right sided valvular disease in the context<br />of gastrointestinal carcinoid is associated with severe and poorly controlled disease. Up to<br />4% of these cases have metastatic disease on the valves, and 3.8% have direct myocardial<br />involvement.</p>Edna JuarezAvinash AdigaPaloma SanchezHilal Fanasch
Copyright (c) 2017 Edna Juarez, Avinash Adiga, Paloma Sanchez, Hilal Fanasch
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2017-10-162017-10-16521263110.12746/swrccc.v5i21.416Pulmonary artery aneurysm secondary to congenital pulmonic valve stenosishttp://pulmonarychronicles.com/index.php/pulmonarychronicles/article/view/425
<p>Pulmonary artery (PA) aneurysms are uncommon and often diagnosed post-mortem. They<br />are characterized by a PA/aorta diameter ratio greater than 2 on transthoracic echocardiography<br />or a pulmonary artery diameter greater than 4 or 5 cm on computed tomography. The most<br />common conditions associated with pulmonary artery aneurysm are congenital heart defects<br />with left-to-right shunts and pulmonic valve abnormalities. There are also numerous causes<br />of acquired pulmonary artery aneurysms, including infection, vasculitis, pulmonary arterial<br />hypertension, trauma, neoplasm and pulmonary embolism. Symptoms of PA aneurysm are<br />usually non-specific, and physical examination findings are variable depending on the underlying<br />cause. Work-up includes various imaging modalities, transthoracic echocardiography, and right<br />heart catheterization. The gold standard treatment is surgery, but in select patients, conservative<br />management with close monitoring can be pursued.</p>Audra SchwalkGilbert Berdine
Copyright (c) 2017 Audra Schwalk, Gilbert Berdine
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2017-10-162017-10-16521323510.12746/swrccc.v5i21.425Affordable health care: what it means and how do we fix our current unaffordable systemhttp://pulmonarychronicles.com/index.php/pulmonarychronicles/article/view/415
Gilbert Berdine
Copyright (c) 2017 Gilbert Berdine
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2017-10-162017-10-16521364110.12746/swrccc.v5i21.415Thrombus in Transithttp://pulmonarychronicles.com/index.php/pulmonarychronicles/article/view/412
Brittany Rosales
Copyright (c) 2017 Brittany Rosales
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2017-10-162017-10-16521424310.12746/swrccc.v5i21.412The role of cotton in respiratory symptoms in the fallhttp://pulmonarychronicles.com/index.php/pulmonarychronicles/article/view/422
<p>During the fall, many people in West Texas have worsening respiratory symptoms<br />while cotton is being harvested and ginned. A common complaint is that cotton itself is to<br />blame for nasal and pulmonary manifestations. Allergic sensitivity to cotton is actually quite<br />uncommon, even in workers in textile and processing plants. Mold, especially Alternaria and<br />Aspergillus species, are occasionally found in cotton crops and can be a source of allergens<br />and mycotoxins. Lipopolysaccharides (LPS) from bacteria could have a role in reduction<br />of FEV1 in byssinosis. Enterobacter in cotton dust possesses highly potent LPS which can<br />elicit a strong inflammatory response in workers. Defoliants, desiccants, pesticides, fertilizers<br />and exhaust fumes are also potential irritants of the respiratory tract. Cotton alone is not the<br />primary source of illness during autumn months. A multitude of allergens, microbes, irritants,<br />and chemical agents that co-exist or are a byproduct of cotton harvesting and ginning are<br />potential contributors to respiratory disease.</p>James Tarbox
Copyright (c) 2017 James Tarbox
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2017-10-162017-10-16521444710.12746/swrccc.v5i21.422Regional Medicine Newshttp://pulmonarychronicles.com/index.php/pulmonarychronicles/article/view/426
David Sotello
Copyright (c) 2017 David Sotello
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2017-10-162017-10-1652148The Plague at Ashdodhttp://pulmonarychronicles.com/index.php/pulmonarychronicles/article/view/418
Christian ConradConnie Nugent
Copyright (c) 2017 Christian Conrad, Connie Nugent
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2017-10-162017-10-165214910.12746/swrccc.v5i21.418Non-inferiority trialshttp://pulmonarychronicles.com/index.php/pulmonarychronicles/article/view/424
Shengping YangGilbert Berdine
Copyright (c) 2017 Shengping Yang, Gilbert Berdine
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2017-10-162017-10-16521505210.12746/swrccc.v5i21.424Statistics questions with answershttp://pulmonarychronicles.com/index.php/pulmonarychronicles/article/view/427
Shengping Yang
Copyright (c) 2017 Shengping Yang
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2017-10-162017-10-16521535410.12746/swrccc.v5i21.427Regression of Basal Cell Carcinomas in Multiple Sclerosis Patient on Aubagio Treatmenthttp://pulmonarychronicles.com/index.php/pulmonarychronicles/article/view/414
Judy Park DeWittKleesy L ThomasAshley Sturgeon
Copyright (c) 2017 Judy Park DeWitt, Kleesy L Thomas, Ashley Sturgeon
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2017-10-162017-10-16521555610.12746/swrccc.v5i21.414